Accessing the Benefits from Your Long-Term Care Policy

A long-term care policy holds tremendous value. Reaping the benefits of a policy can be key to maintaining independence and dignity in the face of uncertain circumstances.  Additionally, having a policy with an insurance company that provides additional resources that clarify service options and offer a list of qualified providers available in a specific area can bring peace of mind.  Picture a scenario in which a husband and wife thoroughly planned for an event by purchasing a long-term care policy. Unfortunately, an unexpected life event occurred and their daily lives as they knew it were significantly changed. Medical treatments cause alterations in living arrangements and financial budgets. Fortunately for those who have done the proper planning, having access to long-term care policy benefits can alleviate some of the stress prompted by the chaos. In situations such as this one, it is necessary that you know how to obtain the benefits of your long-term care policy. Here is a simple guide explaining how to obtain these benefits.

Step one: Contact the insurance company and request a claim packet. These can be accessed online or as a physical copy. If you can’t get immediate access to a claim packet, contact your insurance advisor or financial planner.  It can also be valuable to ask whether a suggested service provider is eligible for policy benefits or if the insurance company can recommend services and/or providers in a given area. Either the client or someone else on their behalf can contact the insurance company to request the claim packet.  Once you have the packet, there are some things you need to know in order to fill it out.  Here is a quick look at what to expect in the initial claims packet:

  • Policyholder statement – summary of medical events reflecting on possible need of care. Be sure to keep track of details such as dates of doctor visits and/or hospitalizations as well as any invoices for care paid for ‘out of pocket’.
  • Attending Physician Statement – brief summary from the doctor acknowledging need of care for at least 2 of 6 Activities of Daily Living.
  • Nursing assessment – summary of medical issues and a “Plan of Care”.
  • Provider statement – details of what care is provided with an invoice.  Can either be for “in-home care” or a “facility” that offers services.
  • HIPPA form – signed authorization to provide access to the client’s medical files.

Step two: The next step in the process is diligent follow up.  Unfortunately, it will take a lot of focused effort to gather all these details to present to the insurance company.  The person charged with getting this accomplished can be a family member, friend, or advocate, and needs to be diligent and attentive to detail.  Gathering all the claim packet information can be frustrating but is necessary to retrieve the financial benefits of the policy.  Once your claim is approved, you can expect to start receiving benefits once the “Elimination Period” of the policy has occurred.  For most policies in force today, the “Elimination Period” typically takes 90 days.

We believe that beginning the claim process at the first sign of an event is the most prudent approach because the claim forms will likely take several weeks before they are ready to be submitted to the insurance company.

The value of planning for an unforeseen medical event through long term care insurance can bring security during a very uncertain time.  Having quality care paid for from the policy benefits can go a long way in helping both care givers and family members each do what they do best. We advocate starting the claim process early after a medical event knowing that it will take time and diligent effort to be able to begin receiving the long-term care benefits that were originally planned for.

If you have questions about the benefits of a long-term care policy and would like more information, the experts at Acru Insurance will be glad to help.

For more information, contact

Jim Crone, CLU®, CFS
Acru Insurance

This article was originally published on LinkedIn and has been republished here with permission by Jim Crone CLU®, CFS and Acru Insurance.